High blood sugar can make it hard to get hard: Men with diabetes are significantly more likely to have erectile dysfunction that those with normal blood sugar readings, new research in the journal Diabetic Medicine concludes. That’s a problem, since diabetes cases have increased four-fold since 1980.

After crunching the numbers from 145 studies including over 88,000 men who averaged 56 years old, the researchers determined that those with diabetes were more than three times as likely to have erectile dysfunction than healthy guys were. In fact, 59 percent of men with diabetes had ED.

What’s more, men with diabetes tended to develop their erectile dysfunction 10 to 15 years earlier than those without the condition did, according to the study. (Want to keep your penis healthy for life?

So how can high blood sugar sink you in the bedroom?

Diabetes can damage your blood vessels and your nerves—both of which are needed for healthy erectile functioning, says Sean Skeldon, M.D., who has previously researched ED and diabetes, but was not involved in this study.

Another important point: Erectile dysfunction is often considered a harbinger of heart disease. That’s because the blood vessel issues that cause ED—say, like plaque buildup—can also affect your heart, too. They just manifest first with problems in the bedroom, since your blood vessels in your penis are smaller than the ones that carry blood to your heart. (Here are 8 other weird facts you never knew about your heart.)

The good news, though, is that many of the risk factors for diabetes are under your control—meaning your penis and your heart could benefit from some prevention strategies. One easy one? Eat three servings of legumes a week. That can cut your risk of diabetes by 35 percent, as we recently reported, possibly because their fiber can help prevent blood sugar spikes.

It should come as no surprise that our diet plays a critical role in our health and longevity, but the sheer level of influence may come as a shock to you.

A new study published in the March 7 issue of JAMA found that poor diet is responsible for an astonishing 45 percent of all deaths from heart disease, stroke and type 2 diabetes in the US. The researchers attributed this high mortality rate to the Standard American Diet (SAD), which is high in sodium, processed meats, sugar-sweetened beverages and unprocessed red meats.

The good news is, just as diet can be our downfall, it’s also just as powerful in promoting exceptional health and longevity — as seen in “Blue Zone” cultures, who are known for their extraordinary lifespan and phenomenal vitality.

A Deadly Trinity of Disease, Directly Linked to Poor Food Choices

According to the newly released JAMA study, which was funded by the National Heart, Lung and Blood Institute (NHLBI), nearly half of all US deaths in 2012 caused by cardiometabolic diseases — like heart disease, stroke and type 2 diabetes — are due to poor diet. Out of the 702,308 adult deaths from cardiometabolic diseases, 318,656 — about 45 percent — were linked with over-consumption of certain unhealthy foods, as well as low consumption of specific nutrient dense edibles.

“Nationally, estimated cardiometabolic deaths related to insufficient healthier foods/nutrients remained at least as substantial as those related to excess unhealthful foods/nutrients,” said lead researcher Renata Micha, RD, PhD, of the Tufts Friedman School of Nutrition Science and Policy, Boston.

Excess consumption of sodium was associated with the highest percentage of death. Consuming high amounts of processed meats, sugar-sweetened beverages and unprocessed red meat were also linked with high mortality. Americans also don’t eat enough of certain health-promoting foods — like fruit, vegetables, nuts and seeds, whole grains, polyunsaturated fats and seafood omega-3 fats.

“Among unhealthful foods/nutrients, the present findings suggest that sodium is a key target,” noted the researchers. “Population-wide salt reduction policies that include a strong government role to educate the public and engage industry to gradually reduce salt content in processed foods (for example, as implemented in the United Kingdom and Turkey) appear to be effective, equitable, and highly cost-effective or even cost-saving.”

According to a press release from the NHLBI:

“The study also shows that the proportion of deaths associated with diet varied across population groups. For instance, death rates were higher among men when compared to women; among blacks and Hispanics compared to whites; and among those with lower education levels, compared with their higher-educated counterparts.”

The findings of the study were based on death certificate data from the National Center of Health Statistics.

With annual US healthcare spending hitting $3.8 trillion in 2014 and $3.2 trillion in 2016 — heart disease and stroke costing nearly $1 billion a day in medical costs along with lost productivity, and diabetes totaling $245 billion annually — the results of this study come as a stark reality check. However, they can also help encourage positive outcomes, such as new public health strategies, public education programs, and revamped industry standards.

For inspiration, we can also look to cultures and communities that have outstanding health and longevity for guidance — and a perfect place to start is with the Blue Zones.

The Island Where People Forgot to Die

Just off the coast of Turkey, very close to Samos, where Pythagoras and Epicurus lived, is a Greek island named Ikaria that is renown as “the island where people forgot to die” because of the exceptional lifespan of its inhabitants. Included in what is referred to as the Blue Zones — five regions in Europe, Latin America, Asia and the US with the highest concentrations of centenarians in the world — the people of Ikaria live about eight years longer than average and have exceedingly good health. These communities are also largely free of health complaints like obesity, cancer, diabetes and heart disease. Moreover, they’re sharp to the very end, whereas in the US, almost half the population over 85 suffers from dementia.

Diet is a key ingredient to their robust health and longevity. In Ikaria, they’re eating a variety of a Mediterranean diet, but with lots of potatoes. They also consume high amounts of beans. One unique foodstuff is called horta, a weed-like green that’s eaten as a salad, lightly steamed or baked into pies. Goat’s milk, wine, honey, some fruit and small amounts of fish are also enjoyed. Other foods include feta cheese, lemons and herbs such as sage and marjoram, which are made into tea.

Lifestyle also comes into play. Plenty of sex (even in old age) and napping are integral aspects of the culture, as is physical activity. There are no treadmills or aerobic classes here. Instead, exercise involves planting and maintaining a garden, manual labor (houses in Ikaria only have hand tools) and walking to run errands.

Another Blue Zone region is Sardinia, Italy where goat’s milk and sheep’s cheese are staples, along with moderate amounts of flat bread, sourdough bread and barley. They also eat plenty of fennel, fava beans, tomatoes, chickpeas, almonds, milk thistle tea and wine from Grenache grapes.

Seventh-day Adventists in Loma Linda, California made the list as well. The community shuns smoking, drinking and dancing, while also avoiding movies, television and other media distractions. Their diet focuses on grains, fruits, nuts, vegetables — and they only drink water. Sugar, except for natural sources found in whole fruit, is taboo. Adventists who follow the religion’s lifestyle live about 10 years longer than those who don’t. Interestingly, pesco-vegetarians in the community, who include up to one serving of fish per day with their plant-based diet, live longer than vegan Adventists. Avocados, salmon, beans, oatmeal, avocados, whole wheat bread and soy milk make up the bulk of their diet.

Nicoya Peninsula in Costa Rica also has a high number of centenarians. Theirs is a traditional Mesoamerican diet of beans, corn and squash — plus papayas, yams, bananas and peach palms (an oval fruit dense in vitamins A and C).

The smallest meal of the day is always in the late afternoon or evening.

Diet consists mostly plants, especially beans. Meat is eaten rarely — on average of just five times a month — and in small portions of about 3 to 4 ounces.

Moderate amounts of wine is consumed with 1-2 glasses per day (doesn’t apply to Seventh-day Adventists).

A sense of community and close social bonds, often with religious underpinnings.

Although the secret to Blue Zone longevity doesn’t rely exclusively on diet, it’s certainly a core foundation for their exceptional health and vitality. We can take a cue from these regions and integrate their wisdom into our own lives for improved well-being. Have a look at these quick and easy Blue Zone recipes for inspiration.

The January 2016 issue of the journal Diabetes Care reported the outcome of a randomized trial that revealed a beneficial role for testosterone treatmentin men with diabetes.

“We hypothesized that testosterone may be an anti-inflammatory and insulin sensitizing agent since it has been known for some time that testosterone reduces adiposity and increases skeletal muscle,” remarked lead researcher Paresh Dandona, MD, PhD, who is a Distinguished Professor at the State University of New York and chief of endocrinology, diabetes and metabolism in the Department of Medicine in the Jacobs School of Medicine and Biomedical Sciences at the University of Buffalo. “Our previous work has shown that obesity is associated with oxidative stress and inflammation, and inflammatory mediators are known to interfere with insulin signaling.”

The trial included 94 type 2 diabetic men, among whom 44 had low testosterone levels and reduced insulin signaling genes indicative of decreased insulin sensitivity. Participants with low testosterone received a weekly testosterone injection or a placebo for 24 weeks. Body weight, body fat, markers of inflammation, insulin sensitivity and other factors were assessed before and after treatment.

At the end of the trial, men who received testosterone experienced a more than six pound average loss of body fat and an equal increase in muscle mass. They also had lower levels of the inflammatory markers C-reactive protein, interleukin-1b and tumor necrosis factor-a. “Most importantly, we saw a dramatic increase in insulin sensitivity, demonstrated by a 32 percent increase in the uptake of glucose by tissues in response to insulin,” Dr Dandona reported.

“Testosterone treatment for men, where indicated, will improve sexual function and increase skeletal muscle strength and bone density,” Dr Dandona noted. “This is the first definitive evidence that testosterone is an insulin sensitizer and hence a metabolic hormone.”

Long-term use of the popular diabetes drug metformin is linked with vitamin B12 deficiency and anemia, according to new research that solidifies some previous research.

“We have essentially confirmed what many smaller studies have suggested,” says Jill Crandall, MD, professor of clinical medicine at the Albert Einstein College of Medicine, the Bronx, who led the new study. “There is a small but significant risk of developing Vitamin B12 deficiency when people take metformin.”

The finding, she adds, ”has implications for the consequences of B12 deficiency.” These can include cognitive impairment, nerve problems (neuropathy) and anemia (low red blood cell count). B12 is crucial for the proper formation of red blood cells, for neurological functioning and for making DNA.

The link between taking the popular diabetes drug and deficiencies in vitamin B12 has been discussed as long ago as 1969, according to Dr. Crandall. However, few studies have looked at long term use, as her new study has done, tracking people for up to 13 years.

The new study was published online Feb. 22 in the Journal of Clinical Endocrinology & Metabolism.

Overview of the Metformin Study

The researchers evaluated more than 2,000 men and women enrolled in the Diabetes Prevention Program and the Diabetes Prevention Program Outcomes Study. In these studies, researchers enrolled overweight people who had prediabetes (blood sugar levels higher than normal but not high enough to be termed diabetes) to see if modest weight loss or treatment with metformin could prevent or delay the onset of type 2 diabetes, then followed them to see if the effects endured.

Half of the participants were given 850 milligrams of metformin twice daily and half got placebo pills. At the 5-year mark, more of those in the metformin group than the placebo group had low B12 levels, affecting 4.3% of the metformin group but just 2.3% of the placebo group. However, the gap narrowed at 13 years, with 7.4% of the metformin group and 5.4% of the placebo group having low B12 at that point. The narrowed gap seems counter-intuitive until Dr. Crandall explains what is happening. “As time goes on, the groups are a little contaminated,” Dr. Crandall says, because some in the placebo group, as time went on, developed diabetes and had to begin taking metformin.

Years of use was linked with an increased risk of B12 deficiency, Dr. Crandall found. Those taking metformin were more likely to have anemia, regardless of their B12 status. Those taking metformin with low B12 were more likely to have neuropathy.

The study findings suggest that routine testing of Vitamin B12 should be considered in patients on metformin treatment, Dr. Crandall says. Experts think that metformin affects the way Vitamin B12 is absorbed by the body. “People should be aware of this possibility,” Dr. Crandall says of the metformin and low B12 link. Currently, she says, there are no official recommendations for B12 testing of those on metformin.

Metformin & Vitamin B12: Second Opinion

“I think it lends more support to a practice that is already in place with endocrinologists,” says Minisha Sood, MD, director of inpatient diabetes at the Lenox Hill Hospital, New York, of the study findings. She reviewed the research but didn’t participate in it.

She screens for Vitamin B12 deficiency in her patients ”at least annually if on metformin.” According to Dr. Sood, many endocrinologists do screen for B12 deficiencies in those on metformin. However, she says, many patients with diabetes who are on metformin are cared for by general practice physicians or internists. These patients should ask their doctor’s advice about getting screened for B12 deficiencies, Dr. Sood says.

B12 Deficiency Symptoms & Treatment

Symptoms of B12 deficiency may include numbness, tingling in the feet, and memory problems, Dr. Crandall says. Loss of appetite, weight loss and fatigue can occur. The deficiency typically develops slowly over time, so the regular screening could detect it early.

Treatment includes a weekly B12 injection and then switching to oral vitamins.

The recommended dietary allowance (RDA) for B12 is 2.4 micrograms for those age 14 and older. Foods high in B12 include cooked clams and beef liver, fortified breakfast cereals and fish such as salmon and trout.

Written by: Kathleen Doheny With commentary by Jill Crandall, MD, professor of clinical medicine, Albert Einstein College of Medicine, New York.

The type of sugar you eat—and not just calorie count—may determine your risk for chronic disease. A new study is the first of its kind to compare the effects of two types of sugar on metabolic and vascular function. The paper is published ahead of print in the American Journal of Physiology—Heart and Circulatory Physiology.

Female rats were given a liquid solution of either glucose (a form of sugar found naturally in the body after carbohydrates are broken down) or fructose (sugar found in fruit and fruit juices) in addition to their normal diet of solid food. The rats received the sweetened solutions for eight weeks, roughly equivalent to a person eating large amounts of sugar for six years. The sugar-fed rats were compared with a control group that received plain drinking water in addition to their food supply.

Researchers found that although both sugar-fed groups consumed more calories than the control group, the total calorie intake of the glucose-fed rats was higher than the rats that were given fructose. Another surprising observation was that “despite this difference, only the fructose group exhibited a significant increase in final body weight,” wrote the research team.

In addition to higher weight gain, the fructose group showed more markers of vascular disease and liver damage than the glucose group. These included high triglycerides, increased liver weight, decreased fat burning in the liver (a factor that can contribute to fatty liver) and impaired relaxation of the aorta, which can affect blood pressure.

These findings suggest that an increase in the amount of calories consumed due to sweeteners is not the only factor involved in long-term health risks. The type of sugar may also play a role in increasing risk factors for heart disease, diabetes and other chronic diseases.

While long used as a flavoring, current research is beginning to confirm health benefits of cinnamon, whose traditional therapeutic use included treatment of chronic bronchitis.1

Cinnamon Controls Diabetes

In a trial of type 2 diabetics reported in 2006, an extract of cinnamon that provided the equivalent of 3 grams powdered cinnamon consumed daily for four months resulted in a 10.3% reduction in fasting plasma glucose from levels measured at the beginning of the study, compared with a 3.4% reduction in the placebo group.2 Participants with higher fasting plasma glucose levels at the beginning of the study derived the greatest benefit.

Cinnamon has also been shown to lower hemoglobin A1c, a marker of long-term glucose control. A randomized trial of 109 type 2 diabetics with elevated hemoglobin A1c levels who received usual care in addition to 1 gram cinnamon daily for 90 days resulted in greater reduction in hemoglobin A1c in comparison with usual care alone.3

Additionally, a trial of 58 poorly controlled type 2 diabetic men and women found reductions in hemoglobin A1c as well as mean systolic and diastolic blood pressures after 12 weeks of cinnamon supplementation compared with a placebo group.4

In Chinese type 2 diabetics, 120 or 360 milligram per day doses of cinnamon extract in addition to gliclazide therapy for three months resulted in a reduction in hemoglobin A1c and fasting blood glucose levels while these levels remained unchanged in the placebo group.5

In a trial that included overweight or obese subjects with impaired fasting blood glucose, cinnamon given twice daily for 12 weeks was associated with an increase in plasma antioxidant status and a decrease in malondialdehyde, a marker of oxidative stress.6

“This study supports the hypothesis that the inclusion of water soluble cinnamon compounds in the diet could reduce risk factors associated with diabetes and cardiovascular disease,” authors A. M. Roussel and colleagues conclude.

Cinnamon Helps Maintain Optimal Blood Sugar Control

A trial ofhealthy subjects conducted by Swedish researchers found a decrease in blood glucose after eating and a delay in gastric emptying among those who received 6 grams cinnamon compared to those who did not receive it.7

A subsequent study conducted by the Swedish team that evaluated the effects of 1 and 3 grams cinnamon revealed a reduction in serum insulin and an increase in glucagon-like peptide 1 (a hormone that helps prevent high blood glucose levels) in those who received the 3 gram dose.8

A subsequent study conducted by the researchers in which healthy men were supplemented with 3 grams cinnamon or a placebo for 14 days resulted in reductions in glucose and insulin responses to oral glucose tolerance testing at the end of the treatment period, however, these benefits were rapidly lost once cinnamon was discontinued.10

Polycystic ovary syndrome (PCOS) is a condition not necessarily characterized by cystic ovaries (as its name implies) but by insulin resistance. In a pilot study involving 15 women with PCOS, cinnamon consumed daily for eight weeks resulted in significant improvement in insulin resistance compared to a placebo as indicated by fasting and two hour oral glucose tolerance test results.12

Interestingly, a recent article appearing in Food and Chemical Toxicology suggests that cinnamon inhibits the misfolding of human islet amyloid polypeptide that is regarded as a causative factor in type 2 diabetes mellitus.13The authors of the study identified proanthocyanidins as the main anti-amyloidogenic compounds occurring in cinnamon water extract and discovered that these compounds also decreased human islet amyloid polypeptide aggregation’s damaging and toxic effects.

A review published in 2007 concluded that cinnamon was well tolerated and has a “possible modest effect in lowering plasma glucose levels in subjects with poorly controlled type 2 diabetes”, and adds the usual disclaimer that diabetics should not use cinnamon in place of the proven standard of care.14

A meta-analysis of eight randomized placebo-controlled trials involving participants with diabetes and/or prediabetes published in 2011 concluded that “Cinnamon intake, either as whole cinnamon or as cinnamon extract, results in a statistically significant lowering in fasting blood glucose.”15
Subsequent meta-analyses of six and ten clinical trials involving diabetics came to similar conclusions.16,17

Cinnamon has shown its value among populations who are looking to optimize their glycemic control. There appears to be a variety of valuable, recent human studies on this beloved ancient spice.

We conclude this review with a study of hyperglycemic subjects who were given a 250 mg dried water-extract cinnamon capsule twice per day or a placebo. Participants in this 2010 study showed a reduction in fasting glucose after two months.18 One should take immediate action at the first signs of hyperglycemia to lessen the chances that diabetes will develop.

References:

Ziment I. Respiration. 1991;58 Suppl 1:37-42.

Mang B et al. Eur J Clin Invest. 2006 May;36(5):340-4.

Crawford P. J Am Board Fam Med. 2009 Sep-Oct;22(5):507-12.

Akilen R et al. Diabet Med. 2010 Oct;27(10):1159-67.

Lu T et al. Nutr Res. 2012 Jun;32(6):408-12.

Roussel AM et al. J Am Coll Nutr. 2009 Feb;28(1):16-21.

Hlebowicz J et al. Am J Clin Nutr. 2007 Jun;85(6):1552-6.

Hlebowicz J et al. Am J Clin Nutr. 2009 Mar;89(3):815-21.

Solomon TPJ et al. Diabetes Obes Metab. 2007 Nov;9(6):895-901.

Solomon TP et al. Eur J Appl Physiol. 2009 Apr;105(6):969-76.

Askari F et al. Nutr Res. 2014 Feb;34(2):143-8.

Wang JG et al. Fertil Steril. 2007 Jul;88(1):240-3.

Jiao L et al. Food Chem Toxicol. 2013 Jun;56:398-405.

Pham AQ et al. Pharmacotherapy. 2007 Apr;27(4):595-9.

Davis PA et al. J Med Food. 2011 Sep;14(9):884-9.

Akilen R et al. Clin Nutr. 2012 Oct;31(5):609-15.

Allen RW et al. Ann Fam Med. 2013 Sep-Oct;11(5):452-9.

Barbara J Stoecker, et al. The Journal of the Federation of American Societies for Experimental Biology. April 2010, 24 meeting abstract supplement 722.1

For the first time, researchers have identified how testosterone helps men regulate blood sugar by triggering key signaling mechanisms in islets, clusters of cells within the pancreas that produce insulin. The findings, co–authored by Tulane University researchers, were published in the journal Cell Metabolism. The study could help identify new treatments for type 2 diabetes in the large number of men with low testosterone due to age or prostate cancer therapies. Researchers used specially bred male mice with pancreatic beta cells lacking the receptor to testosterone (the androgen receptor). They fed them a Western diet rich in fats and sugar and tested their response to glucose. The mice without androgen receptors all developed lower insulin secretion, leading to glucose intolerance compared with normal mice in the control group. To better understand how testosterone interacted with insulin production within the pancreas, researchers administered testosterone and glucose directly to human islet cells treated with an androgen receptor inhibitor and islets cells harvested from mice without androgen receptors. In both cases the islet cells showed decreased insulin production compared to islet cells whose receptor to testosterone was not inhibited or missing. Further experiments in cultured mouse and human islet cells showed the insulin–producing effect of testosterone could be abolished by inhibiting glucagon–like peptide–1 (GLP–1), a hormone the body produces after a meal. The study suggests that testosterone amplifies the islet impact of the hormone, which is currently used as a diabetes treatment.